Guglielmo Ramieri

Background: Odontogenic keratocysts (OKC) recur frequently. We evaluated surgical outcomes and predictors of recurrence in OKC, using orthokeratinized odontogenic cysts (OOC) as a comparison group. Methods: In this multicenter retrospective study, 113 consecutive patients (54 OKC, 59 OOC) treated in four northwestern Italian centres in 2015–2025 were included. Recurrence-free survival was analysed with Kaplan–Meier and Cox methods (107 patients with ≥12 months’ follow-up); initial treatment was compared within OKC, and a sensitivity analysis excluded patients operated on before 2015. Results: Median follow-up was 4 years. A first recurrence occurred in 40/54 OKC (74.1%; 95% CI 60.3–85.0%) and 7/59 OOC (11.9%); 5-year recurrence-free survival was 37.0% versus 70.9% (p < 0.001), and OKC histotype was the only independent predictor (hazard ratio 5.76; 95% CI 2.47–13.45). Within OKC, initial treatment was not associated with recurrence (p = 0.810); in the incident cohort, the recurrence rate was 72.5%. None of the eight patients treated with adjuvant therapy (three OKC with topical 5-fluorouracil) recurred after a median follow-up of 2.5 years. Conclusions: In this real-world series, three-quarters of OKC recurred, and histotype was the dominant prognostic factor; the absence of recurrence after adjuvant therapy is hypothesis-generating and requires prospective confirmation with long-term follow-up.

Background: Preoperative planning in maxillofacial and orthognathic surgery requires anatomical references to guide the definition of functional and aesthetic treatment objectives. Currently available planning tools do not provide quantitative, clinically interpretable three-dimensional morphological targets that are tailored to patient’s sex- and geography-specific characteristics. This study proposes a methodological pipeline for the development of sex-specific 3D facial normotypes in a population of healthy, normal-weight Caucasian young adults to serve as a reference for maxillofacial surgery planning. Methods: The approach is based on the integration of validated anthropometric references with three-dimensional data acquired using 3D scanners. Semi-automatic landmarking was performed on the acquired faces, and a comprehensive set of literature-acknowledged morphometric features and related reference ranges were extracted; a multivariate statistical analysis was applied. Results: The final collected database comprised 109 Caucasian subjects (70 females, 64.2%) that served as a quantitative basis for designing a female and male facial normotype in the form of 3D models. The developed normotypes showed high agreement with the literature-based reference ranges, reaching 95% for the male model and 91% for the female model. Conclusions: This study proposes a methodological approach integrating classical anthropometry with 3D digital modeling. The resulting normotypes represent consistent morphological face models and provide a quantitative and morphologically interpretable reference framework. This framework may support the future development of interactive tools and quantitative assessment metrics for surgical planning. However, its clinical applicability has not yet been validated, and further studies are required to assess its reliability and potential utility in surgical planning.

Objectives: To develop and validate a fully digital, surgeon-oriented interactive framework for final dental occlusion alignment in orthognathic patients. Methods: A digital framework integrating automatic alignment, using a two-dimensional Iterative Closest Point (2D ICP) algorithm with geometric corrections and optimization-based refinement, and an interactive graphical user interface (GUI) for standardized manual refinement were implemented in MATLAB. Validation was performed on preoperative digital models from 21 orthognathic patients. Obtained digital occlusions were compared with manually articulated physical models, considered the reference standard. Translational and rotational discrepancies were assessed before and after manual refinement. Results: Twenty-one patients were included. Manual refinement reduced the greatest translational directional bias along the Y-axis (MV: −2.26 ± 2.1 to −1.17 ± 0.92 mm) and significantly decreased the magnitude of corresponding error (MAV: 2.54 ± 1.73 to 1.26 ± 0.78 mm; p = 0.002). Error magnitude also decreased along the X-axis (1.12 ± 0.84 to 0.38 ± 0.31 mm; p = 0.002), whereas a small increase was observed along the Z-axis (0.93 to 1.21 mm; p = 0.02). Overall translational RMSE improved significantly (1.83 ± 0.91 to 1.09 ± 0.39 mm; p = 0.001). Among rotational components, yaw showed the greatest reduction in error magnitude (MAV: 2.61 ± 1.91° to 0.83 ± 0.71°; p = 0.001), while no statistically significant changes were detected for pitch (p = 0.09) or roll (p = 0.13). Rotational RMSE decreased from 2.00 ± 1.01° to 1.35 ± 0.25° (p = 0.01). Conclusions: The proposed pipeline was completed for all cases. Automatic alignment provided a reliable starting point, but standardized manual refinement remained essential.

Background: The odontogenic keratocyst (OKC) is an aggressive intraosseous cyst with a high recurrence rate. Optimal surgical management remains debated, and independent predictors of recurrence require further analysis. The aim of this study is to evaluate surgical treatment outcomes for OKC across a spectrum of approaches and to identify clinical, demographic, and histopathological predictors of recurrence over long-term follow-up. Methods: A multicenter retrospective study was conducted. A total of 113 patients with histologically confirmed OKC treated between 2015 and 2025 were included. univariate and multivariate logistic regression analyses were performed to assess associations between clinical variables and recurrence. Results: First-stage recurrence occurred in 47/113 patients (41.6%). Histotype was the only independent predictor of recurrence, with 85% of parakeratinized and 15% of orthokeratinized cases. No recurrences were observed among 8 patients treated with excision combined with adjuvant therapy (cryotherapy or topical 5-fluorouracil), compared with 44.8% in the remaining cohort. Analyses for second- and third-stage recurrence did not identify significant predictors, likely due to limited event numbers. Conclusions: Parakeratinized histotype is the dominant predictor of OKC recurrence. Adjuvant therapy — particularly topical 5-fluorouracil or cryotherapy — was associated with absence of recurrence and should be considered in standard management. Long-term follow-up is essential.

Objectives: To develop and validate a fully digital, surgeon-oriented interactive framework for final dental occlusion alignment in orthognathic patients. Methods: A digital framework integrating automatic alignment, using a two-dimensional Iterative Closest Point (2D ICP) algorithm with geometric corrections and optimization-based refinement, and an interactive graphical user interface (GUI) for standardized manual refinement were implemented in MATLAB. Validation was performed on preoperative digital models from 21 orthognathic patients. Obtained digital occlusions were compared with manually articulated physical models, considered the reference standard. Translational and rotational discrepancies were assessed before and after manual refinement. Results: The workflow was successfully completed in all 21 patients. Automatic alignment showed the largest translational discrepancy along the Y-axis (−2.26 ± 2.10 mm), which significantly improved after manual refinement (−1.17 ± 0.92 mm; p = 0.02). A small but significant increase in Z-axis discrepancy was observed (−0.91 ± 0.58 mm vs −1.19 ± 0.44 mm; p = 0.04), whereas X-axis differences were not significant (p = 0.22). Overall translational RMSE decreased significantly (1.83 ± 0.91 mm vs 1.09 ± 0.39 mm; p = 0.001). Individual rotational errors were unchanged (p = 0.08; p = 0.39; p = 0.43 for X-, Y- and Z-axes). Rotational RMSE significantly decreased from 2.00° ± 1.01° to 1.35° ± 0.25° (p = 0.01). Manual refinement reduced error variability, with standard deviations decreasing after standardized refinement. Conclusions: The proposed framework achieved high agreement with the reference manual occlusion. Automatic alignment provided a reliable starting point, but standardized manual refinement remained essential.

Background/Objectives: Temporomandibular joint (TMJ) ankylosis, characterized by osseous–fibrous fusion, severely impairs mandibular function. While alloplastic total joint replacement (TJR) is the gold standard, long-term outcomes remain understudied. The aim of this study is to evaluate the long-term esthetic and functional outcomes of prosthetic replacement and to retrospectively analyze our 20-year experience. Methods: A retrospective observational study (2003–2024) was conducted at a tertiary referral center in Turin and enrolled patients who underwent alloplastic total joint replacement for TMJ ankylosis. Data collected included demographic variables, etiology, characteristics of the ankylosis, prosthesis type (stock/custom), surgical details, and outcomes (maximal interincisal opening [MIO], pain, quality of life, diet consistency, Helkimo index, complications). Results: Among 28 patients (61% female, mean age 51.8 years), etiologies included post-traumatic (39%), osteoarthritis (32%), congenital (25%) and neoplastic (4%) causes. Custom prostheses were used in 57% of cases. Median follow-up was 11.5 years. Significant improvements were observed in MIO (p = 0.001), pain level (p = 0.001), quality of life (p = 0.001), diet score (p = 0.002), and Helkimo index (p = 0.001). Complications included facial nerve dysfunction (32.1%), salivary leakage (14.3%), and one recurrence (2.2%). Conclusions: Alloplstic TJR provides durable functional and esthetic restoration for TMJ ankylosis, with custom prostheses excelling in complex anatomies. Long-term stability (>10 years) supports its role as a definitive solution.

Background: Mandibular reconstruction has evolved significantly since its inception in the early 1900s. Currently, the fibula free flap (FFF) is considered the gold standard for mandibular and maxillary reconstructions, particularly for extensive defects, and the introduction of Extended Reality (XR) and virtual surgical planning (VSP) is revolutionizing maxillofacial surgery. Methods: This study focuses on evaluating the accuracy of using in-house cutting guides for mandibular reconstruction with FFF supported by virtual surgical planning (VSP). Planned and intraoperative osteotomies obtained from postoperative CT scans were compared in 17 patients who met the inclusion criteria. The proposed analysis included measurements of deviation angles, thickness at the centre of gravity, and the maximum thickness of the deviation volume. Additionally, a mandibular resection coding including 12 configurations was defined to classify and analyze the precision of mandibular osteotomies and investigate systematic errors. Preoperative, planned, and postoperative models have been inserted in an interactive VR environment, VieweR, to enhance surgical planning and outcome analysis. Results: The results proved the efficiency of adopting customized cutting guides and highlighted the critical role of advanced technologies such as CAD/CAM and VR in modern maxillofacial surgery. A novel coding system including 12 possible configurations was developed to classify and analyze the precision of mandibular osteotomies. This system considers (1) the position of the cutting blade relative to the cutting plane of the mandibular guide; (2) the position of the intersection axis between the planned and intraoperative osteotomy relative to the mandible; (3) the direction of rotation of the intraoperative osteotomy plane around the intersection axis from the upper view of the model. Conclusions: This study demonstrates the accuracy and reliability of in-house cutting guides for mandibular reconstruction using fibula free flaps (FFF) supported by virtual surgical planning (VSP). The comparison between planned and intraoperative osteotomies confirmed the precision of this approach, with minimal deviations observed. These findings highlight the critical role of CAD/CAM and XR technologies in modern maxillofacial surgery, offering improved surgical precision and optimizing patient outcomes.

Objectives: This study aimed to determine the impact of standing electric scooters on maxillofacial on the Italian territory. Methods: The authors analyzed the epidemiology of the injuries to define electric mobility’s impact on maxillofacial surgery practice. For this retrospective cohort study, data were collected by unifying the standing e-scooter-related fractures database from 10 Italian maxillofacial surgery departments. The reference period considered was from January 2020 to December 2023. The main data considered included age, gender, type of access, time slot of admission, type of admission, alcohol level, helmet use, dynamics of the accident, and area of the fracture. Results: A total of 79 patients were enrolled. The average age of the participants was approximately 31 years. The blood alcohol level was found to be above the Italian norm in 15 cases (19%). Only one patient wore a helmet. The most affected facial third was the middle one with 36 cases (45.5%), followed by the lower one (31, 39.3%). The most recurrent patterns were fractures of the orbito-malar-zygomatic complex (15, 19%), followed by multifocal (bifocal, trifocal) fractures of the mandible (14, 17.5%). Conclusions: This study demonstrated how maxillofacial fractures related to the use of electric scooters are associated with complex patterns, associated with a high rate of post-surgical aftermaths.